Integrated oct-refractometer system for ocular biometry

ABSTRACT

A Slit-lamp-or-Microscope-Integrated-OCT-Refractometer system includes an eye-visualization system, configured to provide a visual image of an imaged region in an eye; an Optical Coherence Tomographic (OCT) imaging system, configured to generate an OCT image of the imaged region; a refractometer, configured to generate a refractive mapping of the imaged region; and an analyzer, configured to determine refractive characteristics of the eye based on the OCT image and the refractive mapping, wherein the refractometer and the OCT imaging system are integrated into the eye visualization system.

BACKGROUND

Technical Field

Embodiments disclosed herein are related to Integrated-OCT-Refractometersystems. In more detail, embodiments are related to eye-visualizationsystems, Optical Coherence Tomographic (OCT) imaging systems, andrefractometers to determine refractive characteristics of the eye basedon the OCT image and a refractive mapping.

Related Art

Current ophthalmic refractive surgical methods, such as cataractsurgery, intra-corneal inlays, Laser-Assisted in situ Keratomileusis(LASIK), and photorefractive keratectomy (PRK), rely on ocular biometrydata to prescribe the best refractive correction. Historically,ophthalmic surgical procedures used ultrasonic biometry instruments toimage portions of the eye. In some cases these biometric instrumentsgenerated an A-scan of the eye: an acoustic echo signal from allinterfaces along an imaging axis that was typically aligned with anoptical axis of the eye: either parallel with it, or making only a smallangle. Other instruments generated B-scan, essentially assembling acollection of A-scans, taken successively as a head or tip of thebiometry instrument was scanned along a scanning line. This scanningline was typically lateral to the optical axis of the eye. Theseultrasonic A- or B-scans were then used to measure and determinebiometry data, such as an ocular Axial Length, an Anterior Depth of theeye, or the radii of corneal curvature. Examples of such ultrasonicocular biometry devices include the Alcon UltraScan and Alcon OcuScanRxP.

In some surgical procedures a second, separate keratometer was used tomeasure refractive properties and data of the cornea The ultrasonicmeasurements and the refractive data were then combined in asemi-empirical formula to calculate the characteristics of the optimalIntra Ocular Lens (IOL) to be prescribed and inserted during thesubsequent cataract phaco surgery.

More recently, the ultrasonic biometry devices have been rapidly givingway to optical imaging and biometry instruments that are built on theprinciple of Optical Coherence Tomography (OCT). Examples include theZeiss IOL Master and the Haag-Streit Lenstar. Such OCT instruments arenow used in 80-90% of all IOL prescription cases. Among others, theirsuccess is due to the non-contact nature of the imaging and to thehigher precision than that of the ultrasound biometers.

Even with these recent advances, however, substantial further growth anddevelopment is needed for the functionalities of the biometric andimaging instruments.

SUMMARY

1. One of the problems with the present instruments is that the methodsthat are used to determine biometrical information heavily rely onassumptions going into the used eye-models, such as the speed ofultrasound in the various ocular media and the refractive indices ofvarious ocular media. They are also based on a simplified representationof the human eye, such as the assumption that the refractive index andthe ultrasound speed do not vary with intra-ocular location and time,whereas in reality they do. Accordingly, a system that models the eyewith measured eye-parameters instead of using assumptions would providebetter accuracy.

2. Further, the applied models use average values, averaged overrefractive results from many surgeries and large patient populations. Assuch, the present methods are based on averaged information and neglector underestimate patient-to-patient variations. These variations caninclude variations with age, gender, region, and other factors. A systemthat can capture patient-to-patient variations would improve thesurgical choices.

3. The ocular biometry measurements are typically performed weeks priorto cataract surgery, in a medical or ophthalmic office. However, therecan be non-negligible changes in the biometry of the patient's eye inthe weeks leading up to the surgery. These changes can be compounded bythe preparation for the surgery itself, such as the administering ofrelaxants and other pharmaceuticals, as well as the differences betweenthe surgical theater and the medical office. Thus, a system that canprovide biometric information closer to the time of surgery would behelpful.

4. Moreover, since the biometrical measurements are performed on acataractous eye, the optical signals are often blurred or distorted tosome degree. Hence the prescription based on the eye-modeling sometimesdeviates from the optimal prescription. Hence, a system that providesbiometric information based on un-blurred measurements provides enhancedprecision.

5. Since in present procedures separate biometrical and imaginginstruments are used, the biometrical and imaging data needs to becross-referenced and registered, which raises additional challenges. Asystem that has integrated measurement capability can provide a betterregistration.

6. Beyond all the above problems of the preparatory biometry and imagingthat can deliver sub-optimal results for a particular eye of aparticular patient at a particular time, an additional problem is thatbiometry is not available during the surgery, even though it couldprovide useful additional feedback and control information for thesurgeon. The first example is the stage when the relaxing incisions havebeen performed based on pre-operative biometry, but the IOL has not beeninserted yet. At this point, a system that can carry out additionalmeasurements to check whether having performed the prescribed incisionsindeed achieved the refractive results predicted by the pre-operationalmodeling could be useful to provide additional corrections oradjustments.

7. Another utility of the intra-operative biometry can be that when atoric IOL is inserted into an astigmatic eye, the axis of the toric IOLshould be optimally oriented relative to the astigmatism of the eye.Presently, the surgeon is guided by the prescription based on thepre-operative biometry. However, it can be helpful to track theorientation of the axis of the toric IOL by intra-operative biometry toensure that the IOL axis is indeed oriented by the surgeon asprescribed. Furthermore, such a system could perform an additionalintra-operative biometry to check whether the pre-operative prescriptionfor the orientation angle remains indeed optimal. The result of thisbiometry can be relayed to the surgeon in a heads-up display inside thesurgical microscope to guide the orientation of the toric axisefficiently.

8. In a similar vein, the centration of the IOL during cataract surgeryis important as well. Again, an intra-operative biometry system canprovide very useful guidance for the surgeon who carries out the IOLinsertion.

At least for these reasons 1-8, the need exists for instruments andmethods that deliver integrated imaging and biometric informationrelated to an individual eye of an individual patient at a time suitablefor making and adjusting step of the cataract surgery, IOL selection andinsertion.

Remarkably, in spite of these needed functionalities, the integration ofthe refractive and imaging instruments is in its infancy. In particular,presently no intra-operative microscope is available with a refractivebiometric device and an OCT imaging system integrated into it.

To address the above needs, embodiments of the present invention includea Slit-lamp-or-Microscope-Integrated-OCT-Refractometer system comprisingan eye-visualization system, configured to provide a visual image of animaged region in an eye; an Optical Coherence Tomographic (OCT) imagingsystem, configured to generate an OCT image of the imaged region; arefractometer, configured to generate a refractive mapping of the imagedregion; and an analyzer, configured to determine refractivecharacteristics of the eye based on the OCT image and the refractivemapping, wherein the refractometer and the OCT imaging system areintegrated into the eye visualization system.

Some embodiments include an intra-operative biometer, comprising: asurgical microscope, configured to provide a visual image of an imagedregion in an eye; an Optical Coherence Tomographic (OCT) imaging system,configured to generate an OCT image of the imaged region; arefractometer, configured to determine refractive information of theimaged region; an analyzer, configured to determine biometricinformation of the eye based on the OCT image and the refractiveinformation; and a heads-up display, configured to display thedetermined biometric information in an optical pathway of the surgicalmicroscope.

Some embodiments include a method of operating an integratedOCT-refractometer system, the method comprising: generating an OCT imageof an ophthalmic imaged region of an eye with an OCT imaging system;generating a refractive mapping of the ophthalmic imaged region with arefractometer; performing an integrated biometric analysis of the eyewith an analyzer, based on the OCT image, the refractive mapping and aneye model; generating a biometric information with the analyzer based onthe biometric analysis to inform a surgical choice; and displaying thebiometric information via one of a video-display and a heads-up display.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram illustrating an embodiment of a Slitlamp-or-Microscope-Integrated-OCT-Refractometer System.

FIGS. 2A-D are diagrams illustrating embodiments of Slitlamp-or-Microscope-Integrated-OCT-Refractometer System.

FIG. 3A-C are diagrams illustrating a particular embodiment of amicroscope with an Integrated-OCT-Refractometer System.

FIG. 4 illustrates a method of operating an integrated OCT-Refractometersystem.

In the drawings, elements having the same designation have the same orsimilar functions.

DETAILED DESCRIPTION

In the following description specific details are set forth describingcertain embodiments. It will be apparent, however, to one skilled in theart that the disclosed embodiments may be practiced without some or allof these specific details. The specific embodiments presented are meantto be illustrative, but not limiting. One skilled in the art may realizeother material that, although not specifically described herein, iswithin the scope and spirit of this disclosure.

Embodiments of the present invention address the above outlined needs1-8. In particular, instruments and methods according to the presentinvention include an Integrated-OCT-Refractometer System for ocularbiometry that addresses those needs. Since this integrated system can bemounted on either a microscope or a slit lamp, it will be referred to asa Slit lamp-or-Microscope-Integrated-OCT-Refractometer System, orSMIORS. Slit-lamp-integrated systems can be useful for ophthalmicoffice-based systems where the surgical planning is performed.Microscope-integrated systems can be useful in an ophthalmic surgicaltheater. Embodiments of the SMIORS address the above needs as follows.

1. Embodiments of SMIORS can be configured to determine the refractiveindices and characteristics and biometric information of the individualeyes of the individual patient. SMIORSs can be configured to utilizeoptical ray tracing software to build a custom eye biometry model.

Such a customized model can be used to prescribe cataract refractivesurgery that provides customized refractive correction. Examples ofoptimizing the cataract surgery include planning out the type, locationand orientation of the inserted IOLs, as well as planning the size,shape and placement of limbal relaxing incisions.

Moreover, if the eye of the patient exhibits, for example, a spatialvariation of the refractive index, SMIORs can be capable of capturingthis variation on some level and perform the biometric analysisaccordingly.

2. In the same vein, embodiments of SMIORs can form a custom eyebiometry model instead of using population-averaged values. In someother embodiments, SMIORSs can use a standard eye model, but withcustomized parameters. This is another aspect in which SMIORSs candeliver more precise surgical planning than the presentpopulation-averaged surgical planners.

3. Embodiments of SMIORSs can also be capable of determining the abovebiometric information very close to the time of the actual surgery, suchas a surgical preparatory step. Accordingly, SMIORSs can avoid problemsarising from the substantial time difference between the surgicalplanning office-visit and the subsequent cataract operation, and thechange of the conditions between the two.

4. A SMIORS can perform biometrical measurements in the aphakic eye,i.e. after the cataractous lens has been removed. This allows the SMIORSto provide optical information that is not blurred by the cataract.Comparing the biometry of the aphakic eye with the pre-surgical modelinghelps the surgeon to re-run the modeling simulations and modify theprescriptions as necessary.

5. Embodiments of SMIORSs can also be integrated: the OCT imaging systemand the refractive system can be mounted on the same microscope insteadof using the devices separately that would require subsequentregistering and referencing. In the integrated SMIORSs, the refractiveand OCT imaging information can be registered more reliably andprecisely.

6. Some embodiments of SMIORs can be configured to perform biometry andrefractive measurements intra-operatively. Such a SMIORS offers multipleadvantages. For example, when the relaxing incisions have been performedin an early step of the cataract surgery, but the IOL has not beeninserted yet, embodiments of the SMIORS can be used to perform abiometric measurement to check whether having performed the prescribedincisions indeed achieved the results predicted by the modeling. If not,the surgeon may wish to select an IOL that is different from theprescription based only on pre-operative biometry.

7. Another utility of the intra-operative biometry can be that when atoric IOL is inserted into an astigmatic eye, the axis of the toric IOLneeds to be optimally oriented relative to the astigmatism. Presently,the surgeon is guided by the prescription of the pre-operative biometry.Clearly, it can be helpful to perform additional intra-operativebiometry to check the orientation of the toric IOL as it is beinginserted by the surgeon. Also, the intra-operative biometry can checkwhether the pre-operative prescription was indeed optimal. The result ofthis biometry can be relayed to the surgeon in a heads-up display insidethe surgical microscope to guide the orientation of the toric axisefficiently.

8. Intra-operative biometry can also provide invaluable feedback for thesurgeon as he or she attempts to center the IOL into the capsule. Asbefore, providing the results of the intra-operative biometry in aheads-up display inside the surgical microscope can be particularlyeffective.

Some SMIORSs can address the just-described needs by getting mounted orintegrated into a surgical microscope. Some embodiments can be capableof avoiding an invasion into the surgery space, in contrast to existingmicroscope-based OCT devices. For example, SWIORSs can be implementedinto an existing port of the microscope. Since the demand for space inthe design of a surgical microscope is particularly pressing, this canbe a substantial advantage. Some SMIORS embodiments can be implementedby increasing the height of the microscope binoculars by less than 2inches, or even by less than 1 inch.

Here it is mentioned that some existing systems managed to integrate arefractometer into a microscope. However, such systems provide onlyincomplete imaging information. Embodiments of the SMIORS offer a morecomplete imaging and biometry information by additionally integrating anOCT imaging system into the microscope or slit lamp as well.

FIG. 1 illustrates an embodiment of aSlit-lamp-or-Microscope-Integrated-OCT-Refractometer System, or SMIORS100. The SMIORS 100 can include an eye-visualization system 110,configured to provide a visual image of an imaged region in an eye 10,an Optical Coherence Tomographic (OCT) imaging system 120, configured togenerate an OCT image of the imaged region; a refractometer 130,configured to generate a refractive mapping of the imaged region; and ananalyzer 140, configured to determine refractive characteristics of theeye based on the OCT image and the refractive mapping, wherein the OCTimaging system 120 and the refractometer 130 can be integrated into theeye visualization system 110.

The imaged region can be a portion or a region of the eye 10, such as atarget of a surgical procedure. In a corneal procedure, the imagedregion can be a portion of a cornea 12. In a cataract surgery, theimaged region can be a capsule and the (crystalline) lens 14 of the eye.The imaged region may also include the anterior chamber of the eye. In aretinal procedure, the imaged region can be a region of the retina 16.Any combination of the above imaged regions can be an imaged region aswell.

The eye-visualization system 110 can include a microscope 112. In otherembodiments, it can include a slit-lamp. The microscope 112 can be anoptical microscope, a surgical microscope, a video-microscope, or acombination thereof. In the embodiment of FIG. 1, the eye-visualizationsystem 110 (shown in thick solid line) can include the surgicalmicroscope 112 that can include an objective 113, optics 115 and abinocular or ocular 117. The eye-visualization system 110 can alsoinclude a camera 118 of a video microscope.

The SMIORS 100 can further include the Optical Coherence Tomographic(OCT) imaging system 120. The OCT imaging system 120 can generate an OCTimage of the imaged region. The OCT imaging system can be configured togenerate an A-scan or a B-scan of the imaged region. The OCT image orimage information can be outputted in an “OCT out” signal that can beused by the analyzer 140 in combination with an outputted “Refractiveout” signal to determine biometric or refractive characteristics of theeye.

The OCT imaging system 120 can involve an OCT laser operating at awavelength range of 500-2,000 nm, in some embodiments at a range of900-1,400 nm. The OCT imaging system 120 can be a time-domain, afrequency-domain, a swept-frequency, or a Fourier Domain Mode Locking(FDML) OCT system 120.

Part of the OCT 120 can be integrated into the microscope, and part ofit can be installed in a separate console. In some embodiments, the OCTportion integrated into the microscope can include only the OCT lightsource, such as the OCT laser. The OCT laser or imaging light, returnedfrom the eye, can be fed into a fiber and driven to a second portion ofthe OCT 120, an OCT interferometer outside the microscope. The OCTinterferometer can be located in a separate console, where suitableelectronics is also located to process the OCT interferometric signals.

Embodiments of the OCT laser can have a coherence length that is longerthan an extent of an anterior chamber of the eye, such as the distancebetween a corneal apex to a lens apex. This distance is approximately 6mm in most patients, thus such embodiments can have a coherence lengthin the 4-10 mm range. Other embodiments can have a coherence length tocover an entire axial length of the eye, such as 30-50 mm. Yet otherscan have an intermediate coherence length, such as in the 10-30 mmrange, finally some embodiments can have a coherence length longer than50 mm. Some swept-frequency lasers are approaching these coherencelength ranges. Some Fourier Domain Mode Locking (FDML) lasers arealready capable of delivering a laser beam with a coherence length inthese ranges.

The SMIORS 100 can further include the refractometer 130 to generate arefractive mapping of the imaged region. The refractometer 130 may beany of the widely used types, including a laser ray tracer, aShack-Hartmann, a Talbot-Moire, or another refractometer. Therefractometer 130 can include a wavefront analyzer, an aberrationdetector, or an aberrometer. Some references use these terms essentiallyinterchangeably or synonymously. A dynamic range of the refractometer130 can cover both phakic and aphakic eyes, i.e. the eyes with andwithout the natural lens. Embodiments of the refractometer 130 will bediscussed at greater length in relation to FIGS. 2A-D.

In some SMIORS 100 the OCT imaging system 120 and the refractometer 130can be integrated via a microscope interface 150 that can include a(down-) beamsplitter 152 d to provide an optical coupling into the mainoptical pathway of the microscope 112 or slit-lamp. A mirror 154-1 cancouple the light of the refractometer 130 into the optical path, and amirror 154-2 can couple the light of the OCT 120 into the optical path.The microscope interface 150, its beamsplitter 152 d, and mirrors154-1/2 can integrate the OCT imaging system 120 and the refractometer130 with the eye-visualization system 110.

In embodiments, where the OCT imaging system 120 operates in the nearinfrared (IR) range of 900-1,400 nm, and the refractometer operates inthe 700-900 nm range, the beamsplitter 152 d can be close to 100%transparent in the visible range of 400 nm-700 nm, and close to 100%reflective in the near-IR range of 700-1,400 nm range for highefficiency and low noise operations.

By the same token, in a SMIORS 100 where the mirror 154-1 redirectslight into the refractometer 130, the mirror 154-1 can be close-to-100%reflective in the near IR range of 700-900 nm, and the mirror 154-2 canbe close-to-100% refractive in the near IR range of 900-1,400 nm,redirecting to the OCT imaging system 120. Here, “close-to-100%” canrefer to a value in the 50-100% range in some embodiments, or to a valuein the 80-100% range in others.

In some specific embodiments, the beamsplitter 152 d can have areflectance in the 50-100% range for a wavelength in the 700-1,400 nmrange, and a reflectance in the 0-50% range for a wavelength in the400-700 nm range.

FIG. 1 shows that the SMIORS 100 can include a second, up-beam splitter152 u besides the down-beam splitter 152 d. The down-beam-splitter 152 dcan direct light between the objective 113 and the integrated OCT120/refractometer 130 ensemble. The up-beam-splitter 152 u can directlight between a display 160 and the binocular 117, as described below.

The analyzer, or controller, 140 can perform the integrated biometricalanalysis based on the received OCT and refractive information. Theanalysis can make use of a wide variety of well-known optical softwaresystems and products, including ray tracing software and computer-aideddesign (CAD) software. The result of the integrated biometry can be (1)a value of the optical power of portions of the eye and a correspondingsuggested or prescribed diopter for a suitable IOL; (2) a value and anorientation of an astigmatism of the cornea, and suggested or prescribedtoric parameters of a toric IOL to compensate this astigmatism; and (3)a suggested or prescribed location and length of one or more relaxingincisions to correct this astigmatism, among others.

The analyzer 140 can output the result of this integrated biometrytowards the display 160, so that the display 160 can display theseresults for the surgeon. Display 160 can be an electronic video-displayor a computerized display, associated with the eye-visualization system110. In other embodiments, the display 160 can be a display in closeproximity of the microscope 112, such as attached to the outside of themicroscope 112. Finally, in some embodiments, display 160 can be amicro-display, or heads-up display, that projects the display light intothe optical pathway of the microscope 112. The projection can be coupledinto the main optical pathway via a mirror 157. In other embodiments,the entire heads-up display 160 can be located inside the microscope112, or integrated with a port of the microscope 112.

FIG. 1 illustrates such an embodiment, where the display 160 is aheads-up display that projects the biometric information back towardsthe microscope interface 150 via the mirror 157. In such embodiments,microscope interface 150 may contain two beam splitters, down-beamsplitter 152 d and up-beam splitter 152 u. The down-beam splitter 152 dcan redirect the light of the OCT 120 and the refractometer 130 towardsthe patient's eye and redirect the light from the eye 10 towards the OCT120 and refractometer 130. The up-beam-splitter 152 u can redirect thedisplay light from the heads-up display 160 towards the binocular orocular 117 of the microscope, so that the surgeon can view the displayedbiometric information intra-operatively and make informed decisionsbased on this displayed biometrics.

FIG. 2A illustrates an embodiment of the refractometer 130 that involvesa Shack-Hartmann (SH) refractometer 130. The SH refractometer 130 caninclude a refractive laser source 131, whose light is coupled into themain optical pathway of the surgical microscope 112 through the mirror154-1, and the microscope interface 150. As described above, inembodiments where there are two beam splitters, the light of therefractometer 130 can be directed to a down-beam-splitter 152 d thatredirects the light towards the objective 113 and the patient's eye 10.In these two-beam-splitter embodiments, the microscope interface 150 caninclude two achromatizators 153, or achromats 153 for short.

The light that is returned from the imaged region of the eye 10 can beredirected by the same down-beam-splitter 152 d and reach mirror 154-2,where it can be reflected to a refractive sensor 132 that can include alenslet array 133 to receive the refractive light beam returned from theimaged region and to decompose it into beamlets. The lenslet array 133can focus the beamlets onto a SH-detector 134, or detector-array 134that can detect the beamlets individually and to perform the refractivemapping of the imaged region based on the detected beamlets. TheSH-detector or SH-detector array 134 can output a “refractive out”signal, carrying the refractive information computed from the detectedbeamlets. The refractive mapping of the imaged region itself, based onthe detected beamlets, can be performed by a processor directlyassociated with the refractometer 130. In other embodiments, thedetected beamlet signals can be forwarded to the separateanalyzer/controller 140 to perform the refractive mapping.

The light of the OCT imaging system 120 can be scanned via an OCTscanner 121, and then coupled into the main optical pathway at a mirror154-3, redirected to the down-beam-splitter 152 d of the microscopeinterface 150. The returned OCT light can be redirected from the mainoptical pathway by the mirror 154-3 and then fed into a fiber optics asthe “OCT out” signal, guided to an external OCT interferometer andelectronics that is located in an external console. In some embodiments,the OCT interferometer and OCT electronics can be part of theanalyzer/controller 140. In other embodiments, the OCT interferometerand OCT electronics can be a separate block.

The eye-visualization system 110 can further include the camera 118 thatcan include a CCD or CMOS array 119 to generate a digital image that canbe outputted as “video out”. CMOS cameras typically work faster than CCDcameras. This can be advantageous to deliver closer-to-real-time imagingand intra-operative information for the surgeon.

In some SMIORS 100 embodiments, several rays can share the same opticalpathway. For example, the light of the refractometer 130, that of theOCT 120 and the light used by the camera 118 can all share the samepathway in some embodiments. Therefore, in some embodiments the returnedlight is decomposed so that the light-components are redirected to thecorresponding sensors and detectors. For example, in FIG. 2A, mirror154-3 redirects the OCT light to the OCT system 120, mirror 154-2redirects the refractive light to the refractometer 130, and theremaining light can reach the camera 118.

This functionality can be achieved by a suitable spectral design. Forexample, the OCT 120 can be designed to operate with an OCT laser lightin the 900-1,400 nm wavelength range. The refractometer 130 can operatewith a refractive laser light in the 700-900 nm range. Finally, thecamera 118 can operate with the visible spectrum of 400-700 nm range.Thus, a spectral design can separate and decompose the light returnedfrom the imaged region if the mirror 154-3 is reflective in the900-1,400 nm range but transmissive at shorter wavelengths, and themirror 154-2 is reflective in the 700-900 nm range but transmissive atshorter wavelengths. Such a spectral design can make sure that theappropriate components of the returned light reach the OCT 120,refractometer 130 and camera 118.

It is noted that the light of the refractive laser 131 is also coupledinto the beam path by the mirror 154-1. For the system 100 to functionproperly, this mirror 154-1 can be half-reflective in the 700-900 nmrange, so that it lets half of the returned refractive light through toreach the mirror 154-2 that redirects this light into the refractivesensor 132.

Besides the mirrors 154-1/4, the beam splitters 152 u/d can also have asuitable spectral design. In some embodiments, the refractometer 130 canoperate with a wavelength in the 700-900 nm range, and be coupled in thean optical pathway of the eye-visualization system 110 via the beamsplitter 152 d that has a reflectance in the 50-100% range for awavelength in the 700-900 nm range.

In some of these embodiments, the OCT imaging system 120 can operatewith a wavelength in the 900-1,400 nm range, and be coupled in the anoptical pathway of the eye-visualization system 110 via the beamsplitter 152 d that has a reflectance in the 50-100% range for awavelength in the 900-1,400 nm range.

Embodiments of SMIORS 100 can be constructed with many other spectraldesigns. The wavelength ranges, the transmissive properties, thereflective properties, and the sequence of optical elements can take awide variety of arrangements, while maintaining the describedfunctionalities.

In particular, the sequence of the camera 118, OCT 120 and refractometer130 along the optical pathway can be any sequence depending on theconsiderations of the spectral design. In some of these embodiments,mirrors with transmissive wavelength-widows may need to be employed,transmitting light within a wavelength range and reflecting above andbelow that range. E.g., in some embodiments, the refractometer 130 canbe the first and the OCT 120 can be positioned after the refractometer130 in the optical pathway.

As discussed above, the analyzer 140 can receive the “OCT out” and“Refractive out” signals. In some embodiments, the analyzer 140 can evenuse the “Video out” signal from the camera 118. The analyzer, orcontroller, 140 can use a wide variety of optical analytic software toanalyze these input signals with an existing eye-model, with a modifiedeye-model, or with a custom eye model.

The eye model can be an Emsley model, a Greivenkamp model, a Gullstrandmodel, a Helmholtz-Laurence model or a Liouu-Brennan model, amongothers. The determined parameters of the eye model can include aspherical parameter, a cylinder parameter, including one or more radiiof curvatures, and an orientation angle of the lens and the cornea. Theanalyzer 140 can be programmed to determine these parameters byexecuting a ray-tracing software. With these software products and the“OCT out” and “Refractive out” signals, the analyzer can perform anintegrated biometric analysis.

The analyzer 140 can perform this analysis with a processor and a memorythat can be programmed to determine parameters of an eye model usingboth the OCT image and the refractive mapping. Part of the analysis canbe that the analyzer registers the OCT image and the refractive mapping.For example, the OCT image can provide a cross sectional image of thecornea that can be used to determine a corneal curvature. An angulardependence of the corneal curvature can be extracted by performing OCTB-scans in several directions. In parallel, the refractive mapping canprovide information about the optical properties of the cornea.Combining the refractive and OCT images therefore can develop a detailedcharacterization of an astigmatism of the cornea.

The outcome of this analysis can be a refractive characteristic of theeye itself. In some embodiments, the analyzer 140 can be configured todetermine the refractive characteristics of the procedure eye 10 bydetermining some or all parameters of one of the above eye models forthe procedure eye. This can be viewed as the analyzer 140individualizing an eye model for the eye of the particular patient.

Once the parameters of the eye model have been determined by theanalyzer 140, the analyzer 140 can proceed to perform the biometricanalysis. This biometric analysis can be performed at several differentstages, including: (1) during an office visit substantially before thesurgery, (2) during surgical preparations in the surgical theater, justbefore surgery commences, (3) after surgery has started and relaxingincisions have been created, but before the IOL insertion has started,(4) after the surgery has started and the cataractous nucleus has beenremoved but before the IOL insertion has started, and (5) after the IOLinsertion has started.

In stages (1) and (20, in some embodiments, the analyzer can select froma database of available Intra Ocular Lenses (IOLs) to achieve a desiredoptical correction of the procedure eye 10 when inserted into theprocedure eye 10. The desired optical correction can be related to atleast one of the following characteristics of the procedure eye 10: arefractive error, an astigmatism, an optical power, a higher orderaberration, a coma, a Zernike coefficient, a centration, and a tilt.

In some embodiments, the analyzer 140 can be configured to determine arecommended/prescribed IOL optical power, or a value and orientation ofastigmatism of a toric IOL, a multifocal characteristic, and a positionof an Intra Ocular Lens (IOL) in a capsule of the eye to achieve thedesired optical correction of the eye.

Some fast SMIORS 100 embodiments may be configured to performintra-operative biometry in stages (3)-(5). In some embodiments, theanalyzer 140, together with the OCT imaging system 120 and therefractometer 130, can include a programmed processor and memory todetermine the refractive characteristics of the eye within 10 seconds.Such fast SMIORSs 100 can provide biometric and refractive informationintra-operatively, a feature that can be very useful to assist thesurgeon to optimize the refractive surgical outcome.

In some embodiments, the analyzer 140, including a processor and amemory, can be programmed to determine eye-model-parameters from the OCTimage and the refractive mapping in stage (3), i.e. after a relaxingincision has been created in an ophthalmic tissue, and to outputcorrecting biometry information to the display 160 when the determinedeye-model-parameters are different from pre-operatively determinedeye-model-parameters.

In some embodiments, the analyzer 140, including a processor and amemory of the analyzer 140, can be programmed to determineeye-model-parameters from the OCT image and the refractive mapping ofthe aphakic eye in stage (4), i.e. after a natural lens has been removedfrom the eye. The analyzer 140 can output correcting biometryinformation to the display 160 when the determined eye-model-parametersare different from pre-operatively determined eye-model-parameters.

In some embodiments, the analyzer 140 can be programmed to determineeye-model-parameters from the OCT image and the refractive mapping instage (5), i.e. after an insertion of an IOL lens into a capsule of theeye has started; and to output biometry information to a display toadjust at least one of a centration and a toric orientation of the IOLbeing inserted.

The OCT imaging, refractive mapping and biometric analysis can beperformed by various functional blocks. Some of the imaging functionscan be performed by a processor that is associated with the OCT imagingsystem 120, other imaging functions by the analyzer 140. Some of therefractive mapping functions can be performed by a processor that isassociated with the refractometer 130, other refractive mappingfunctions by the analyzer 140.

Once the biometric analysis is performed, analyzer 140 can send thecorresponding information and signals to the display 160. In theembodiment of FIG. 2A, the display 160 is a micro-display, or heads-updisplay 160 that projects the biometric information back into theoptical pathway of the SMIORS 100. In such a SMIORS 100, the displaybeam can be directed to the up-beam-splitter 152 u that can redirect thedisplay beam to the surgeon through the binocular/ocular 117. Such adesign enables the surgeon to maintain the visual observation of thesurgical process while also viewing the biometric information of theheads-up display.

Finally, a fixation LED 137 can be included in some embodiments, toprovide a visible fixation light for the patient to fixate on. Thepatient doing so helps the surgeon to maintain alignment of the SMIORS100 and the patient's eye 10. The light of the fixation LED 137 can becoupled into the optical pathway through a mirror 154-4. In light of theabove considerations, the wavelength of the fixation LED 137 and thewavelength-dependence of the reflective properties of the mirror 154-4can be chosen based on the considerations of the spectral design of theother components. For example, the wavelength can be a narrowly definedpeak in the visible spectrum of 400-700 nm.

FIG. 2B illustrates that other embodiments of the refractometer 130 caninvolve a Talbot-Moire (TM) refractometer. The TM refractometer 130 canagain include a refractive laser source 131, configured to generate alaser beam to be directed to the imaged region partially through anoptical pathway of the surgical microscope 112. The refractive laserbeam can be coupled into the optical pathway through the mirror 154-1.The beam can be subsequently coupled into the main optical pathway ofthe surgical microscope of the eye-visualization system 110 through themicroscope interface 150. In some embodiments, the microscope interface150 can include one or two beam splitters 152 and a corresponding numberof achromatizators 153. In two beam-splitter embodiments, the light ofthe refractometer 130 can be coupled into the main optical pathwaythrough the down-beam-splitter 152 d.

In addition, the TM embodiment 130 can also include the refractivesensor 132 that in this embodiment includes two crossed gratings 135with a variable relative angle to receive the beam returned from theimaged region, and to output a Moire pattern corresponding to thereceived beam. The refractive sensor 132 can also include a detector 136to detect the Moire pattern, and to perform the refractive mapping ofthe imaged region based on the detected Moire pattern. The rest of theembodiment can be analogous to the embodiment of FIG. 2A.

FIG. 2C illustrates another embodiment of the SMIORS 100. Thisembodiment shares several elements with the embodiments of FIGS. 2A-Bthat are analogously numbered. In addition, an embodiment of therefractometer 130 can be a laser ray tracing system. (It is noted herethat the term “laser ray tracing” refers to a hardware implementation ofthe refractometer 130, which involves scanning the rays of therefractive laser beam with hardware means, such as with scanners. Theterm “ray tracing” is also used, however, in describing the software ofthe optical modeling, performed by the analyzer 140. As a matter ofclarification, the software-implemented ray tracing method can be usedwith any and all embodiments of the refractometer 130, including thosein FIGS. 2A-D, not only with the laser ray tracing embodiment of FIG.2C.)

The laser source 131 of the refractometer 130 can include a set ofvertical cavity surface emitting lasers (VCSELs), or another similarmatrix laser source. The VCSEL matrix 131 can, for example, have 16×16individual VCSEL lasers that can emit short pulses in sequence. Thissequence of pulses creates the equivalent of a single laser light,scanned along a scanning pattern. One of the advantages of VCSEL lasersis that by varying the firing sequence of individual VCSEL lasers, awide variety of scanning patterns can be generated with minimaladjustments.

The “scanned beam” of the VCSEL matrix 131 can be coupled into theoptical pathway of the microscope 112 via the mirror 154-1, on its wayto the down-beam-splitter 152 d, getting redirected to the patient'seye.

As the refractive light returns from the imaged region, in theray-tracer embodiment 130 the camera 118 can play the role of therefractive sensor 132 in the following manner. The VCSEL laser matrix131 can be used to generate a circular “scan pattern” by firing theindividual VCSEL lasers is a circular pattern. The ray-tracingrefractometer 130 can scan a refractive laser along a loop to direct thescanned refractive laser to the imaged region, and to record a path therefractive laser sweeps in the imaged region during the scanning. If thepatient's eye is emmetropic, i.e. free of refractive errors, thenthroughout the scan, the “beam” will remain focused to one spot on themacula. In other words, in an emmetropic eye the pulses of eachindividual VCSEL laser of the VCSEL laser matrix 131 hit the same spot,indicating the absence of a refractive error.

Eyes can have at least two types of refractive errors: the scanned beamcan be over-focused or under-focused, i.e. focused proximal to theretina or distal to the retina, respectively. Over-focused beams aresaid to have a positive refractive error, under-focused beams a negativeerror. In both of these cases, as the VCSEL laser is “scanned” along aring or loop, the beam focused by the eye will scan along a ring oflaser spots on the fundus. The larger the ring diameter, the larger therefractive error.

The sign of the refractive error determines the phase between the“scanning” of the VCSEL laser and the scanning of the focused laserspots appearing on fundus. The under-focused beams in an eye withnegative refractive errors do not cross. In such eyes, the VCSEL lasersand the spots scanned on the fundus are in phase. For example, if theVCSEL lasers fire in a clock-wise ring sequence, then the laser spots onthe fundus will be scanned in a clock-wise ring sequence as well.

In contrast, the over-focused beams of an eye with positive refractiveerrors cross before they reach the retina. In such eyes, if the VCSELlasers fire in a clock-wise ring sequence, the laser spots on the funduswill be scanned in a counter-clockwise ring sequence.

In both cases, the camera 118 can play the role of the refractive sensor132. In the outputted “Video out” signal, the camera can indicate theradius or size of the ring or path scanned by the laser spots on thefundus. This can allow the determination of the degree or magnitude ofthe refractive error. The camera can also indicate whether the scanningor firing sequence of the VCSEL lasers and the scanning of the spot onthe fundus are in phase or in opposite phase.

Using the “Video out” signal from the camera 118, the analyzer 140 canbe configured to determine an optical power of the eye, or a portion ofthe eye, from a size of the recorded path, and to determine a sign ofthe optical power of the eye from a phase of the recorded path.

In some embodiments, the determination of the two scans moving in-phaseor out-of-phase can be performed by a position-sensor, sometimes withoutusing the CMOS array 119. The position-sensor of the camera 118 cantrack the detection signal in a low number of pixels, such as four, andcan output a low-resolution representation whether the fundus scan orpath is in- or out-of phase with the loop scan of the refractive VCSELlaser. Such position sensors provide only low-resolution information,but they do so much quicker than full cameras.

Finally, for eyes which have a refractive error with a cylindricalcomponent, the circular/loop scan of the VCSEL laser can cause the spoton the fundus scan along an ellipse path. The angle of ellipse's longaxis determines the astigmatism angle. The relative sizes of the shortand long axii, and their aspect ratio, indicate the spherical andcylindrical errors.

In all these described cases, the camera 118, possibly in combinationwith a quadrant-based position sensor, can serve as the refractivesensor 132. Accordingly, the camera 118 in such ray-tracer embodimentscan be viewed as part of the refractometer 130. The “video out”, or“refractive/video out” data from the camera 118 can be forwarded to theanalyzer 140. The analyzer 140 can also receive the “OCT out” signalfrom the OCT 120.

Integrating these data, the analyzer 140 can determine some biometric orrefractive information to display. This “biometry to display” signalthen can be outputted by the analyzer 140 toward the display 160. In theembodiment of FIG. 2C, the display 160 can be a micro-display, orheads-up display 160 that projects the biometric information into theoptical pathway of the microscope 112 via the up-beam-splitter 152 u, sothat it reaches the surgeon through the binocular or ocular 117.

FIG. 2D illustrates yet another embodiment of SMIORS 100. Thisembodiment shares several elements with the embodiments of FIGS. 2A-Cthat are analogously numbered. This embodiment of the refractometer 130is also a laser ray-tracing system, but one that is integrated with theOCT imaging system 120 even closer. The light, generated by therefractive laser 131, can be coupled into the scanner 121 that is sharedwith the OCT imaging system 120. In other embodiments, the ray tracer130 can have its own scanner. The scanner 121 can sequentially directthe laser ray along a scanning pattern into the imaged region. Thus, theshared scanner 121 of the OCT system can replace, or switch-out, theVCSEL laser matrix scanning system 131 of FIG. 2C. One of the featuresof this switch-out is that in VCSEL systems it can be a challenge tofocus the lights of each individual laser of the laser matrix properly,since they are generated at different points of the matrix. In contrast,embodiments of FIG. 2D have a single laser source 131, helping thefocusing.

As before, the scanned refractive laser light can be coupled by themirror 154-1/3 into the shared optical pathway, and by thedown-beam-splitter 152 d into the main optical pathway of the microscope112. As for the embodiment of FIG. 2C, the returned scanned refractivelight can be received and detected by the camera 118.

The refractive analysis can be performed based on the scanner 121scanning the refractive laser beam in a circle, ring or loop, and thecamera 118 recording the diameter and phase of the path scanned, orswept, by the spot of the refractive laser beam on the fundus. Theoutput of the camera 118 can be coupled into the analyzer 140 as the“refractive/video out” signal, just as the OCT image or data from theOCT system 120 as the “OCT out” signal. Then the analyzer 140 canperform the integrated biometry analysis based on these signals. Theresult of the integrated analysis can be forwarded to the display 160 asthe “biometry to display” signal. The heads-up display, or micro-display160 can project the received biometry information into the main opticalpathway of the microscope 112 via the up-beam-splitter 152 u of themicroscope interface 150.

In the above embodiments of FIGS. 2A-D, the OCT imaging system 120 andthe refractometer 130 can be coupled into the surgical microscope 112 ofthe eye-visualization system 110 proximal to the distalmost lens of themicroscope, thereby avoiding a reduction of a microscope-eye workingdistance. In some embodiments this can be achieved by coupling the OCTimaging system 120 and the refractometer 130 into the surgicalmicroscope 112 through at least one beam-splitter port of the surgicalmicroscope. Such embodiments are capable of limiting the increase of theheight of the microscope oculars or binoculars 117 by less than 2inches, or even by less than 1 inch.

Returning to the existing needs for intra-operative use, articulated inpoints 6-8 earlier, embodiments of the SMIORS 100 can be used to performan integrated analysis of the OCT and refractive information at stage(3). This can be a test of the freshly-formed relaxing incisions thatwere prescribed based on a pre-operative analysis. It can happen in somecases that the relaxing incisions that were prescribed based on thepre-operative analysis resulted in a refractive correction that wasslightly different from the planned one. Performing the intra-operativebiometry in stage (3), can give the surgeon a chance to execute acorrective action, such as to change the previously determined opticalpower of the IOL to be inserted to a different one to additionallycompensate the small un-planned deviation caused by the relaxingincision.

Embodiments of the SMIORS 100 can also be used to perform an integratedanalysis of the OCT and refractive information of an aphakic eye, fromwhich the cataractous lens has been removed. Performing biometry at thisstage (4) can be very useful to test the pre-operatively developedmodeling of the eye now that the cataractous lens has been removed andthe optical signals are not blurred by the cataract. This biometricanalysis after the removal of the cataractous lens but before the IOLinsertion provides a final stage where the surgeon can change theoptical power of the IOL to be inserted in light of the new biometry.

Finally, in some cases the intra-operative biometry can be performed notonly after the removal of the cataractous lens, but at stage (5): afterthe insertion of the IOL has been started by the surgeon. In suchembodiments, for example, the surgeon may have started to insert a toricIOL into the lens capsule. An intra-operative biometry can be performedduring the process to check whether the orientation of the major axis ofthe toric IOL is indeed oriented in the direction prescribed by thepre-operative diagnosis and prescription. Further, this procedure canalso check whether the modeled direction of the toric IOL indeed worksas optimally as the pre-surgical modeling has suggested. In a real-timeintra-operative biometry analysis, the analyzer 140 can discover that achange of the direction of the axis of astigmatism of the alreadyinserted toric IOL may improve the overall optical performance of theeye.

After the analyzer 140 has performed any of these stage (3)-(5)intra-operative biometric analyses, the analyzer 140 may direct theheads-up display 160 to display a suggested rotation of the orientationof the toric IOL for the surgeon in the shared optical pathway of thesurgical microscope 112. In response, the surgeon can immediately adjustthe IOL insertion process accordingly, without ever removing her or hiseye from the microscope 112.

In some analogous embodiments, the SMIORS 100 can include anintra-operative biometer 100, comprising: a surgical microscope 112,configured to provide a visual image of a imaged region in an eye; anOptical Coherence Tomographic (OCT) imaging system 120, configured togenerate an OCT image of the imaged region; a refractometer 130,configured to determine refractive information of the imaged region; ananalyzer 140, configured to determine biometric information of the eyebased on the OCT image and the refractive information; and a heads-updisplay 160, configured to display the determined biometric informationin an optical pathway of the surgical microscope 112. In someembodiments the determined biometric information can be displayedintra-operatively.

FIGS. 3A-C illustrate embodiments of the SMIORS 100 or intra-operativebiometer 100. The eye-visualization system 110 in this embodiment caninclude a surgical microscope 112 that has an objective 113 and abinocular 117. The OCT imaging system 120 and the refractometer 130 canbe integrated into the SMIORS 100 via the microscope interface 150. TheOCT imaging information and the refractive mapping can be forwarded tothe analyzer 140 that can be disposed external to the eye-visualizationsystem 110. The analyzer 140 can perform an integrated biometricanalysis based on the OCT image and the refractive mapping, and generatea biometric information. The analyzer 140 can signal the determinedbiometric information to the heads-up display 160 that is configured todisplay the determined biometric information in an optical pathway ofthe surgical microscope 112.

FIG. 3A illustrates an embodiment where the microscope interface 150 islocated relatively far from the distal objective of the microscope 112.FIG. 3B illustrates an analogous embodiment, differing in that themicroscope interface 150 is located at a more distal position. Finally,FIG. 3C illustrates a mixed embodiment. Here, the OCT 120 and therefractometer 130 can be integrated into a distal microscope interface150, whereas the heads-up display can be coupled to the microscope 112at a proximal location.

Finally, FIG. 4 illustrates a method 200 of operating embodiments of aSMIORS 100. The method 200 can include:

210: generating an OCT image of an ophthalmic imaged region of an eyewith an OCT imaging system, e.g. the OCT imaging system 120;

220: generating a refractive mapping of the ophthalmic imaged regionwith a refractometer, e.g. the refractometer 130;

230: performing an integrated biometric analysis of the eye with ananalyzer, e.g. the analyzer 140, based on the OCT image, the refractivemapping and an eye model;

240: generating a biometric information with the analyzer based on thebiometric analysis to inform a surgical choice; and

250: displaying the biometric information via one of a video-display anda heads-up display, e.g. the display 160.

Embodiments as described herein provide a slit lamp or microscopeintegrated OCT and Refractometer. The examples provided above areexemplary only and are not intended to be limiting. One skilled in theart may readily devise other systems consistent with the disclosedembodiments which are intended to be within the scope of thisdisclosure. As such, the application is limited only by the followingclaims.

1-28. (canceled)
 29. A method for determining refractive characteristicsof an eye, comprising: receiving, from an Optical Coherence Tomographic(OCT) imaging system, OCT image data of an imaged region of the eye;receiving, from a refractometer, refractive mapping data of the imagedregion; registering, by a processor configured to execute opticalanalytic software, the OCT image data and the refractive mapping data;combining, by the processor, the OCT image data and refractive mappingdata; and executing, by the processor, optical ray tracing software todetermine the refractive characteristics of the eye based on thecombined OCT image data and refractive mapping data; and displayingbiometric information indicating the determined refractivecharacteristics of the eye.
 30. The method of claim 29, wherein therefractometer comprises at least one of a Shack-Hartmann refractometer,a Talbot-Moire refractometer, a ray-tracing refractometer, a wavefrontanalyzer, an aberration detector, and an aberrometer.
 31. The method ofclaim 29, wherein the OCT imaging system comprises one of a time-domain,a frequency-domain, a swept frequency, and a Fourier Domain Mode LockingOCT imaging system.
 32. The method of claim 29, wherein executing theoptical ray tracing software to determine the refractive characteristicsof the eye comprises determining one or more parameters of an eye-modelusing both the OCT image data and the refractive mapping data.
 33. Themethod of claim 32, wherein: the eye-model is one of an Emsley model, aGreivenkamp model, a Gullstrand model, a Helmholtz-Laurence model and aLiou-Brennan model; and the one or more parameters of the eye-modelinclude at least one of a spherical parameter, a cylinder parameter, andan orientation angle of an astigmatism of the eye.
 34. The method ofclaim 32, further comprising selecting from a database of availableIntra Ocular Lenses (IOLs), based on the determined parameters of theeye-model, optical characteristics of an IOL to achieve an opticalcorrection of the eye.
 35. The method of claim 34, wherein the opticalcorrection is related to at least one of the following characteristicsof the eye: a spherical refractive error, a cylindrical refractiveerror, an astigmatism value, an astigmatism angle, an optical power, ahigher order aberration, a coma, a Zernike coefficient, a centration,and a tilt.
 36. The method of claim 34, further comprising: determining,by the processor, at least one of a recommended IOL optical power, avalue and orientation of an astigmatism of a toric IOL, a multifocalcharacteristic, and a position of an Intra Ocular Lens (IOL) in acapsule of the eye to achieve the desired optical correction of the eye.37. The method of claim 32, wherein the one or more parameters of theeye-model are determined using both the OCT image data and therefractive mapping data after a natural lens of the eye has beenremoved; and further comprising outputting corrective biometryinformation to a display when the determined eye-model parameters aredifferent from pre-operatively determined eye-model parameters.
 38. Themethod of claim 32, wherein the one or more parameters of the eye-modelare determined using both the OCT image data and the refractive mappingdata after a relaxing incision has been created in an ophthalmic tissue;and further comprising outputting corrective biometry information to adisplay when the determined eye-model parameters are different frompre-operatively determined eye-model parameters.
 39. The method of claim32: wherein the one or more parameters of the eye-model are determinedusing both the OCT image data and the refractive mapping data after anIOL lens has been inserted into a capsule of the eye; and furthercomprising outputting, to a display, biometry information to guide anadjustment of at least one of a centration and a toric orientation ofthe inserted IOL.
 40. The method of claim 29, wherein the refractometerand the OCT imaging system are mounted on a microscope.
 41. The methodof claim 29, wherein refractometer and the OCT imaging system areintegrated with a microscope.
 42. A system for determining refractivecharacteristics of an eye, comprising: an Optical Coherence Tomographic(OCT) imaging system configured to generate OCT image data of an imagedregion of the eye; a refractometer configured to generate refractivemapping data of the imaged region; an optical analytic software programexecutable by a processor, the optical analytic software programconfigured to: receive the OCT image data and the refractive mappingdata; register the OCT image data and the refractive mapping data;combine the OCT image data and refractive mapping data; and executeoptical ray tracing software to determine the refractive characteristicsof the eye based on the combined OCT image data and refractive mappingdata.
 43. The system of claim 42, further comprising: a surgicalmicroscope, configured to provide a visual image of the imaged region ofthe eye, and a display, configured to display biometric informationindicating the determined refractive characteristics of the eye.
 44. Thesystem of claim 42, wherein the refractometer comprises at least one ofa Shack-Hartmann refractometer, a Talbot-Moire refractometer, aray-tracing refractometer, a wavefront analyzer, an aberration detector,and an aberrometer.
 45. The system of claim 42, wherein the OCT imagingsystem comprises one of a time-domain, a frequency-domain, a sweptfrequency, and a Fourier Domain Mode Locking OCT imaging system.
 46. Thesystem of claim 42, wherein the optical analytic software program isfurther configured to determine one or more parameters of an eye-modelusing both the OCT image data and the refractive mapping data.
 47. Thesystem of claim 46, wherein: the eye-model is one of an Emsley model, aGreivenkamp model, a Gullstrand model, a Helmholtz-Laurence model and aLiou-Brennan model; and the one or more parameters of the eye-modelinclude at least one of a spherical parameter, a cylinder parameter, andan orientation angle of an astigmatism of the eye.
 48. The system ofclaim 46, wherein the optical analytic software program is furtherconfigured to select, based on the determined parameters of theeye-model, optical characteristics of an Intra Ocular Lenses (IOL) toachieve an optical correction of the eye.
 49. The system of claim 48,wherein the optical correction is related to at least one of thefollowing characteristics of the eye: a spherical refractive error, acylindrical refractive error, an astigmatism value, an astigmatismangle, an optical power, a higher order aberration, a coma, a Zernikecoefficient, a centration, and a tilt.
 50. The system of claim 48,wherein the optical analytic software program is further configured todetermine at least one of a recommended IOL optical power, a value andorientation of an astigmatism of a toric IOL, a multifocalcharacteristic, and a position of an IOL in a capsule of the eye toachieve the optical correction of the eye.
 51. The system of claim 46,wherein the one or more parameters of the eye-model are determined bythe optical analytic software program after a natural lens of the eyehas been removed; and the optical analytic software program is furtherconfigured to output corrective biometry information to a display whenthe determined eye-model parameters are different from pre-operativelydetermined eye-model parameters.
 52. The system of claim 46, wherein theone or more parameters of the eye-model are determined by the opticalanalytic software program after a relaxing incision has been created inan ophthalmic tissue; and the optical analytic software program isfurther configured to ouput corrective biometry information to a displaywhen the determined eye-model parameters are different frompre-operatively determined eye-model parameters.
 53. The system of claim46, wherein the one or more parameters of the eye-model are determinedby the optical analytic software after an IOL lens has been insertedinto a capsule of the eye; and the optical analytic software program isfurther configured to output, to a display, biometry information toguide an adjustment of at least one of a centration and a toricorientation of the inserted IOL.
 54. The system of claim 42, wherein therefractometer or the OCT imaging system is mounted on a microscope. 55.The method of claim 42, wherein the refractometer or the OCT imagingsystem is integrated with a microscope.
 56. An intra-operative biometersystem, comprising: an Optical Coherence Tomographic (OCT) imagingsystem configured to generate OCT image data of an imaged region of aneye during an ophthalmic operation; a refractometer configured togenerate refractive mapping data of the imaged region during theophthalmic operation; a processor configured to execute an opticalanalytic software program during the ophthalmic operation to: receivethe OCT image data and the refractive mapping data; register the OCTimage data and the refractive mapping data; combine the OCT image dataand refractive mapping data; and execute optical ray tracing softwareduring a surgical procedure to determine one or more parameters of aneye-model based on the combined OCT image data and refractive mappingdata; select, based on the determined parameters of the eye-model,characteristics of an Intra Ocular Lenses (IOL) to achieve an opticalcorrection of the eye; and determine at least one of a recommended IOLoptical power, a value and orientation of an astigmatism of a toric IOL,a multifocal characteristic, and a position of an IOL in a capsule ofthe eye to achieve the optical correction of the eye.